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Cholelithiasis and perforated gallbladder in an infant
Kim Rhoads1, John Snyder, Hanmin Lee
1Department of Surgery, University of California, San Francisco Medical Center, San Francisco, CA, USA.
Insights
Perforated gallbladder in infants is rare. This case highlights successful surgical management including laparotomy and gallbladder bed drainage for a premature infant presenting with abdominal distension and failure to thrive.
Area of Science:
- Pediatric Surgery
- Neonatal Medicine
- Gastroenterology
Background:
- Premature infants, especially those with prolonged parenteral nutrition, are at risk for gastrointestinal complications.
- Abdominal distension and failure to thrive in neonates warrant thorough investigation for underlying pathology.
Observation:
- A 3.5-month-old ex-26-week premature infant presented with abdominal distension and failure to thrive.
- Workup revealed ascites and a complex cystic mass in the porta hepatis.
- Laparotomy identified a perforated gallbladder with gallstones.
Findings:
- Surgical management involved removal of gallstones and drainage of the gallbladder bed.
- Postoperative recovery was uneventful with minimal drain output.
- Extensive hematologic and metabolic workups were unremarkable.
Implications:
- Gallbladder perforation is an exceedingly rare condition in the infant population.
- Prompt surgical intervention, including laparotomy and drainage, is crucial for favorable outcomes.
- This case underscores the importance of considering rare surgical emergencies in neonates with abdominal symptoms.
Abstract:
An infant presented with abdominal distension and failure to thrive. This patient was a 3.5-month-old, ex-26-week premature infant at the time of presentation who required supplemental parenteral nutrition until day 9 of life. Workup found ascites and a complex cystic mass in the porta hepatis. A perforated gallbladder with gallstones was found at laparotomy. The gallstones were removed, and the bed of the gallbladder was drained. Output from the drain was minimal by postoperative day 6, and the drain subsequently was removed. The child did well postoperatively; hematologic and metabolic workups were unrevealing. Perforation of the gallbladder is an exceedingly uncommon finding in infants. Appropriate management includes laparotomy and drainage of the gallbladder bed.